Nursing 612 Exam 3
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Free Nursing 612 Exam 3 Questions
PVD is a disease that alters blood flow to or from the extremities and vital organs other than the heart. According to studies, which of the following remains the most important risk factor for PVD?
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Smoking
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Family history
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Hypercoagulopathy
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Hypertension
Explanation
The Correct Answer is:
A. Smoking.
Detailed Explanation:
Smoking is the most significant and modifiable risk factor for peripheral vascular disease (PVD). Nicotine and other chemicals in tobacco cause vasoconstriction, damage to the endothelium, and promote atherosclerosis, all of which impair blood flow to the extremities. Smoking also decreases oxygen delivery to tissues, accelerates plaque formation, and increases the risk of thrombus development. While family history, hypertension, and hypercoagulopathy contribute to PVD risk, smoking has the strongest direct and dose-dependent association with the disease’s onset and progression.
A patient comes to the health-care provider office for a checkup. The nurse practitioner notes that the patient is 67 years old and is presenting symptoms of dizziness, orthopnea, and edema. The nurse practitioner begins a focused assessment of the:
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Neurological system
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Reproductive system.
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Respiratory system.
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Cardiovascular system.
Explanation
The Correct Answer is:
D. Cardiovascular system.
Detailed Explanation:
The symptoms of dizziness, orthopnea (shortness of breath when lying flat), and edema are hallmark indicators of cardiovascular dysfunction, particularly heart failure or impaired cardiac output. These symptoms reflect decreased efficiency of the heart to pump blood effectively, leading to fluid accumulation and reduced perfusion. A focused cardiovascular assessment—including inspection for jugular venous distention, auscultation for abnormal heart sounds, assessment of peripheral pulses, and evaluation for dependent edema—is essential for diagnosis and management. While respiratory issues may coexist, the root cause is most likely cardiac.
John is 80 years old and is experiencing the following: weight gain, tachycardia, neck vein distention, and cognitive impairment. The nurse practitioner assesses for which of the following to support a diagnosis of heart failure? Select all that apply.
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Laterally displaced point of maximum impulse of apical pulse.
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Asymptomatic
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Rales in bilateral lower lobes not due to atelectasis or ascites.
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Increase in appetite and alertness.
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Functional impairment.
Explanation
The Correct Answers are:
A. Laterally displaced point of maximum impulse of apical pulse, C. Rales in bilateral lower lobes not due to atelectasis or ascites, and E. Functional impairment.
Detailed Explanations:
A. Laterally displaced point of maximum impulse of apical pulse:
A laterally displaced PMI occurs when the left ventricle enlarges due to volume overload or decreased contractility—both common findings in heart failure. It indicates ventricular dilation.
C. Rales in bilateral lower lobes not due to atelectasis or ascites:
Crackles (rales) in the lung bases result from pulmonary congestion and fluid accumulation caused by left-sided heart failure. These are hallmark findings indicating poor cardiac output and pulmonary venous hypertension.
E. Functional impairment:
Heart failure decreases exercise tolerance and daily functioning due to fatigue, dyspnea, and poor perfusion. This functional decline is a key clinical indicator, especially in older adults.
Sharon is a 70-year-old patient with venous ulcers to her right lower extremity. She has a history of multiple pregnancies and surgeries, and has a sedentary lifestyle. Which of the following may be possible contributing factors to her diagnosis given her history? Select all that apply.
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Parkinsonism
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History of breast cancer
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Obesity
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Reduced mobility
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Degenerative disease
Explanation
The Correct Answers are:
C. Obesity and D. Reduced mobility.
Detailed Explanations:
C. Obesity:
Obesity increases venous pressure in the lower extremities, impairing venous return and promoting venous stasis. This leads to valve incompetence, edema, and tissue breakdown—key contributors to venous ulcer formation.
D. Reduced mobility:
A sedentary lifestyle or limited mobility decreases the calf muscle pump function, which normally assists in venous return to the heart. Stagnant blood flow in the lower extremities causes chronic venous insufficiency and ulcer development.
Sam is 64 years old and has been feeling weak, lightheaded, and slightly nauseous. He goes to the urgent care center where the nurse practitioner initiates an assessment. Which of the following suggest an arrhythmia? Select all that apply.
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Palpitations and syncope.
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Chest x-ray showing an increased size of the left atria.
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Lack of family history of any acute heart conditions.
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History of alcohol drinking.
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No history of heart pounding, racing, or skipping beats.
Explanation
The Correct Answers are:
A. Palpitations and syncope and D. History of alcohol drinking.
Detailed Explanations:
A. Palpitations and syncope:
These are classic symptoms of an arrhythmia. Palpitations indicate an irregular or rapid heart rhythm, and syncope (fainting) can occur when the arrhythmia reduces cardiac output, causing transient cerebral hypoperfusion.
D. History of alcohol drinking:
Chronic or excessive alcohol intake, sometimes called “holiday heart syndrome,” can trigger atrial fibrillation or other arrhythmias. Alcohol affects cardiac conduction and electrolyte balance, increasing the likelihood of rhythm disturbances.
The nurse practitioner knows that risk factors for coronary artery disease (CAD) include atherosclerosis. The nurse practitioner includes teaching on these factors that can be remediated to help prevent CAD:
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Age
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Advanced age and male gender.
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Cholesterol levels and smoking.
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Low blood pressure.
Explanation
The Correct Answer is:
C. Cholesterol levels and smoking.
Detailed Explanation:
Atherosclerosis is a primary contributor to coronary artery disease (CAD), and modifiable risk factors play a major role in its prevention. Elevated cholesterol levels lead to plaque buildup in arterial walls, while smoking accelerates endothelial damage, promotes vasoconstriction, and increases platelet aggregation—all of which heighten CAD risk. These factors can be improved through lifestyle changes, diet, and medication.
Treatment to slow the progression of PAD should include which of the following? Select all that apply.
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Conservative
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Surgical
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Pharmacological
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Heat
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Immobilization
Explanation
The Correct Answers are:
A. Conservative, B. Surgical, and C. Pharmacological.
Detailed Explanations:
A. Conservative:
Conservative management is the first-line approach for peripheral arterial disease (PAD). It includes lifestyle modifications such as smoking cessation, regular exercise (especially walking programs), weight control, and a heart-healthy diet. These interventions improve circulation and slow disease progression.
B. Surgical:
Surgical or interventional procedures, such as angioplasty, stent placement, or bypass grafting, are used in severe cases to restore adequate blood flow when conservative and medical therapies are insufficient.
C. Pharmacological:
Medications such as antiplatelet agents (aspirin or clopidogrel), statins, and cilostazol help improve blood flow, prevent clot formation, and reduce atherosclerotic progression.
Mrs. Prentiss is diagnosed with symptomatic AAA. The initial treatment is aggressive blood pressure control. At which of the following readings should mean arterial pressure be maintained?
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Between 80 and 100 mm Hg.
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Between 60 and 70 mm Hg.
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Between 90 and 120 mm Hg.
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Between 100 and 120 mm Hg.
Explanation
The Correct Answer is:
A. Between 80 and 100 mm Hg.
Detailed Explanation:
For patients with symptomatic abdominal aortic aneurysm (AAA), careful blood pressure control is critical to reduce aortic wall stress and prevent rupture. The mean arterial pressure (MAP) should be maintained between 80 and 100 mm Hg to ensure adequate organ perfusion while minimizing pressure on the aneurysm wall. Lower pressures (60–70 mm Hg) risk inadequate perfusion to vital organs, while higher levels (above 100 mm Hg) increase the chance of aneurysm expansion or rupture. Continuous arterial monitoring and IV antihypertensives, such as nicardipine or esmolol, are typically used to maintain this range safely.
The nurse practitioner and a student are examining the apical pulse of an 82-year-old man. The student perceives that there is an S4 sound. The nurse practitioner interprets that this is likely:
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Mitral regurgitation.
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Normal, due to the man's age.
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Heart blockage
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An early ventricular filling.
Explanation
The Correct Answer is:
B. Normal, due to the man's age.
Detailed Explanation:
An S4 heart sound (also called an atrial gallop) occurs just before S1 and results from the atria contracting forcefully to overcome decreased ventricular compliance. This is common in older adults due to age-related stiffening of the ventricular wall or mild diastolic dysfunction. In an elderly person without other signs of heart failure, an S4 is often considered a normal age-related finding.
AAA is mostly atherosclerotic in nature, but can also be caused by trauma, infection, and inflammation. Which of the following is a true statement regarding the tendency to develop AAA? Select all that apply.
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AAA is the 13th leading cause of death in the United States.
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There is no dominant ethnic group that develops AAA.
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Caucasians have a higher risk of developing AAA
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Women have a higher risk of developing AAA.
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There is a familial history associated with AAA development.
Explanation
The Correct Answers are:
A. AAA is the 13th leading cause of death in the United States, C. Caucasians have a higher risk of developing AAA, and E. There is a familial history associated with AAA development.
Detailed Explanations:
A. AAA is the 13th leading cause of death in the United States:
Abdominal aortic aneurysm (AAA) is a significant cause of mortality, particularly among older adults. Ruptured AAAs have a high fatality rate, making it one of the leading causes of sudden death in men over 65.
C. Caucasians have a higher risk of developing AAA:
Epidemiological data show that Caucasian men are at a notably higher risk compared to other ethnic groups. The condition is also more prevalent among individuals with a history of smoking and hypertension.
E. There is a familial history associated with AAA development:
A family history of AAA increases risk due to genetic predisposition affecting connective tissue integrity and vascular elasticity. First-degree relatives of affected individuals should undergo screening.
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